Provider Demographics
NPI:1427887488
Name:WADE, KELSEE (DC)
Entity type:Individual
Prefix:
First Name:KELSEE
Middle Name:
Last Name:WADE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 950
Mailing Address - Street 2:
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75802-0950
Mailing Address - Country:US
Mailing Address - Phone:903-729-3772
Mailing Address - Fax:903-723-0920
Practice Address - Street 1:2114 STATE HIGHWAY 155
Practice Address - Street 2:
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75803-8606
Practice Address - Country:US
Practice Address - Phone:903-729-3772
Practice Address - Fax:903-723-0920
Is Sole Proprietor?:No
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14664111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor